SOUTH LYON FOOT & ANKLE SPECIALISTS, P.C. (NPI# 1003809682) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003809682 |
| Entity Type | Organization |
| Organization Name | SOUTH LYON FOOT & ANKLE SPECIALISTS, P.C. |
| Practice Address |
22245 Pontiac Trl South Lyon MI 48178-1639 |
| Practice Telephone | 2484868886 |
| Practice Fax Number | 2484868887 |
| Mailing Telephone | 2484868886 |
| Mailing Fax Number | 2484868887 |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2009-02-04 |
| Authorized Official Name | DR. ANTHONY MASTROGIOCOMO (OWNER/PRESIDENT/PODIATRIST) |
| Authorized Official Telephone | 2484868886 |
| Authorized Official Credential | DPM |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213E00000X | Podiatrist | ========= | MI | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BCBS | 4856311830 | 01 |
| Street Address |
22245 PONTIAC TRL |
| City | SOUTH LYON |
| State | MI |
| Zip Code | 48178-1639 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720055387 | Anthony Marc Mastrogiacomo | Podiatrist | 22245 Pontiac Trl, South Lyon, MI 48178-1639 | 2006-03-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083231815 | Bhoomi Shah | Pharmacist | 22318 Pontiac Trail, South Lyon, MI 48178 | 2020-06-27 |
| 1649811845 | Center for Emdr and Trauma Therapy | Counselor | 28900 Pontiac Trail, South Lyon, MI 48178 | 2019-09-30 |
| 1295223386 | Cathrine Michelle Arneson | Massage Therapist | 321 Pettibone St. #101a, South Lyon, MI 48178 | 2018-04-25 |
| 1033592936 | 4-serv Family Medicine P.C. | Family Medicine | 51619 Ten Mile Rd, South Lyon, MI 48178 | 2015-07-09 |
| 1003299777 | James Sullivan | Physical Therapy Assistant | 10821 Bouldercrest Drive, South Lyon, MI 48178 | 2015-06-30 |
| 1255722088 | Jennifer Nidetz | Social Worker | 23015 Cheyenne Dr, South Lyon, MI 48178 | 2015-02-16 |
| 1174938658 | Michael Samir Matar | Family Medicine | 210 N Lafayette Street, South Lyon, MI 48178 | 2014-06-24 |
| 1043633191 | Kwonsoo Kenneth Kim | Anesthesiology | 8854 Stoney Creek Dr., South Lyon, MI 48178 | 2014-01-27 |
| 1285071860 | Ajanthan Sivagurunathan | Student in an Organized Health Care Education/Training Program | 210 North Lafayette, Providence Medical Center - South Lyon, South Lyon, MI 48178 | 2013-05-23 |
| 1184890055 | Yvonne Marie Snyder | Dentist | 100 E Lake St, South Lyon, MI 48178 | 2008-05-01 |
| Find all providers in zip 48178 | ||||
| Taxonomy Code | 213E00000X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639373046 | Dr. Raymond H. Durussel, P.C. | Podiatrist | 13650 10 Mile Rd, South Lyon, MI 48178-9143 | 2007-06-12 |
| 1699726703 | Rebecca Anne Baril | Podiatrist | 26012 Pontiac Trl, South Lyon, MI 48178-8050 | 2006-05-13 |
| 1720055387 | Anthony Marc Mastrogiacomo | Podiatrist | 22245 Pontiac Trl, South Lyon, MI 48178-1639 | 2006-03-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679185227 | Richard S Klimecki Dpm | Podiatrist | 30205 Schoenherr Rd Ste A, Warren, MI 48088-6800 | 2020-08-17 |
| 1063037075 | Vikrant Wadehra | Podiatrist | 27629 Chatsworth St, Farmington Hills, MI 48334-1821 | 2020-06-15 |
| 1255963401 | Metrocare Visiting Physicians Pllc | Podiatrist | 5700 Crooks Rd Ste 108, Troy, MI 48098-2818 | 2020-02-06 |
| 1053887869 | Canton Podiatry Pllc | Podiatrist | 42017 Ford Rd, Canton, MI 48187-3669 | 2018-10-18 |
| 1760961577 | Premier Foot & Ankle II Pllc | Podiatrist | 5777 W Maple Rd Ste 170, West Bloomfield, MI 48322-4448 | 2018-08-13 |
| 1609379395 | Nomad Podiatry Pllc | Podiatrist | 28230 S Pointe Ln, New Baltimore, MI 48051-2347 | 2018-03-09 |
| 1861993685 | Steven J. Repitor | Podiatrist | 8244 Metro Pkwy # C, Sterling Heights, MI 48312-2778 | 2018-02-27 |
| 1588179584 | Sheryl Bentzley Dpm PC | Podiatrist | 967 Brooklawn Dr, Troy, MI 48084-2659 | 2017-12-12 |
| 1598287914 | Fadee Ramzi Kakos | Podiatrist | 15830 Fort St Ste 8, Southgate, MI 48195-1348 | 2017-07-07 |
| 1104347178 | Benjamin Hartger | Podiatrist | 600 Park Ave Ste 3, Grand Haven, MI 49417-2173 | 2017-06-29 |
| Find all providers with the same taxonomy | ||||
| City | SOUTH LYON |
| Zip Code | 48178 |
Please comment or provide details below to improve the information on SOUTH LYON FOOT & ANKLE SPECIALISTS, P.C..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.